Dry mouth, also called xerostomia, results from an inadequate flow of saliva. Dry mouth is a symptom rather than a specific disorder. It is not a normal part of aging.
Adequate salivary flow lubricates oral tissues, fights off disease, cleanses the mouth and begins the digestive process as foods are chewed. When salivary flow is reduced, harmful organisms grow in the mouth.
For some people, the sensation of having a dry mouth is simply a nuisance. For others, the condition causes serious health problems. Left untreated, dry mouth may lead to oral infections, a burning sensation, difficulty swallowing, rampant tooth decay, bad breath, and other oral health problems. Many people are surprised to find that after years of good check-ups they have a mouthful of cavities.
Drying irritates the soft tissues, which can make them inflamed and more susceptible to infection. Without the cleansing and shielding effects of adequate salivary flow, tooth decay and periodontal (gum) disease become more common. Constant dryness and the lack of protection provided by saliva contribute to bad breath. Dry mouth also causes full dentures to become less comfortable and a poorer fit, because there is no thin film of saliva to help them adhere properly to oral tissues.
Causes of Dry Mouth
Prescribed and over-the-counter medications are the most common cause of dry mouth. The most common to have side effects of dry mouth are medications used to treat high blood pressure, cholesterol, pain, anxiety/depression and also antihistimines/decongestants. Dry mouth is a potential adverse effect of more than 400 medications. Read the literature that accompanies your medications. If you think a medication is causing dry mouth, tell your dentist or physician. In some cases, a different prescription may provide relief.
Dry mouth also may result from radiation treatment for head and neck cancers, salivary gland disease, emotional stress and autoimmune diseases such as diabetes and Sjogren’s syndrome. Hormonal alterations associated with pregnancy and menopause also have been associated with dry mouth.
Increasing fluid intake sometimes can alleviate dry mouth. Your dentist or physician may recommend using artificial saliva/lubricants (Biotene, Oasis-available at local pharmacies) to keep oral tissues moist. Other remedies include:
- sugar-free gum or candy (to stimulate salivary flow);
- frequent sips of water;
- alcohol-free oral rinses;
- restricted intake of caffeine, alcohol and carbonated beverages;
- use of a humidifier at night;
- Xylitol gum for stimulation of saliva flow.
Regular dental checkups are important, too. Tell the dentist what medications you are taking and other information about your health that may help identify a solution to your oral dryness. The dentist can diagnose any problems in the early stage, when they can be corrected with greater ease.
Taking good care of your teeth and gums is critical if you have dry mouth. This will minimize decay and periodontal disease. Brush twice a day, and floss or use another interdental cleaner once a day to remove debris from between the teeth, where your toothbrush cannot reach. The dentist may recommend additional fluoride products to help control tooth decay, especially varnishes or gels.
If you have issues due to dry mouth, specifically decay, we may prescribe medication therapies as an adjunct to any dental work necessary. Often decay cannot be controlled with just one therapy; a combination works best to fight off the bacteria and try to restore your mouth to a healthy state. Unfortunately, even the best efforts at controlling decay progression can still ultimately lead to extraction. Maintain regular checkups and use all therapeutics as prescribed to give yourself the best chance at maintaining your teeth.
We recommend scheduling your first visit six months after the eruption of their first tooth.
What is tooth decay?
Tooth decay is the process that results in a cavity (dental caries). It occurs when bacteria in your mouth make acids that eat away at a tooth. If not treated, tooth decay can cause pain, infection, and tooth loss. You can prevent tooth decay by brushing and flossing your teeth regularly, seeing your dentist for teeth cleaning and checkups, and avoiding foods high in sugar. All three of these are necessary and important for prevention, and with diligence, can be accomplished.
What causes tooth decay?
The combination of bacteria and food causes tooth decay. A clear, sticky substance called plaque that contains bacteria is always forming on your teeth and gums. As the bacteria feed on the sugars in the food you eat, they make acids. The acids attack the teeth for 20 minutes or more after eating or drinking. More plaque = more bacteria=more acid, especially if you are “feeding” these bacteria more often by snacking or sipping beverages often. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay.
What are the symptoms?
Tooth decay usually does not cause symptoms until you have a cavity or an infected tooth. When this occurs, a toothache is the most common symptom. By this time it may be too late to save the tooth without extensive treatment.
How is tooth decay diagnosed?
Your dentist diagnoses tooth decay by asking questions about your past dental and medical problems and care, examining your teeth, and by taking X-rays of your teeth and mouth to see hidden cavities.
How is it treated?
Treatment for tooth decay depends on how bad it is. You may be able to reverse slight tooth decay by using fluoride. To fix cavities caused by mild tooth decay, your dentist will do a filling. For severe tooth decay, you may need a root canal, crown, or even may have to extract the tooth.
Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw.
What Is the Temporomandibular Joint?
The temporomandibular joint is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side and enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.
What Causes TMD?
The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possible causes include:
- Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
- Dislocation of the soft cushion or disc between the ball and socket
- Presence of osteoarthritis or rheumatoid arthritis in the TMJ
- Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
What Are the Symptoms of TMD?
People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40.
Common symptoms of TMD include:
- Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide
- Limited opening
- Jaws that get “stuck” or “lock” in the open- or closed-mouth position
- Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
- Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
- Swelling on the side of the face
Other common symptoms include toothaches, headaches, neckaches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitis).
How Is TMD Diagnosed?
Because many other conditions can cause similar symptoms – including a toothache, sinus problems, or arthritis – your dentist will conduct a careful patient history and clinical examination to determine the cause of your symptoms.
He or she will examine your temporomandibular joints for pain or tenderness; listen for clicking, popping or grating sounds during jaw movement; look for limited motion or locking of the jaw while opening or closing the mouth; and examine bite and facial muscle function. Sometimes panoramic x-rays will be taken. These full face X-rays allow your dentist to view the entire jaws, TMJ, and teeth to make sure other problems aren’t causing the symptoms.
Your dentist may decide to send you to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This oral healthcare professional specializes in surgical procedures in and about the entire face, mouth and jaw area.
What Treatments Are Available for TMD?
Treatments range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, nonsurgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.
Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, Aleve), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs or other drugs for pain such as narcotic pain relievers. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles.
Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth.
Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem. Have your bite adjusted if recommended.
Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
Don’t rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. Try to control clenching or grinding during the day.
Minimize stress as much as possible.
Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain. Because surgery is irreversible, it is wise to get a second or even third opinion from other dentists and/or oral surgeon.
There are three types of surgery for TMD: arthrocentesis, arthroscopy and open-joint surgery. The type of surgery needed depends on the TMD problem.
TMJ therapy-Stretching exercises:
All are isometric (tension, not movement) exercises.
1. Open and close slightly 10 times, then stretch. Repeat exercise 4 times.
2. With fist under the chin, elbow pointing to the floor, try to open while holding jaw closed. Hold tension for 10 seconds.
3. With right fist against side of lower jaw and elbow straight out, slide jaw into fist while pushing, with pressure against movement. Hold for 10 seconds.
4. Repeat # 3 with left fist. Remember, always push slightly with your fist and pull into your fist with your jaw for resistance (tension). Most problems are one-sided; if your left jaw hurts, you will feel most tension when exercising against your right hand.
5. With your hand cupped over your chin (or with clean fingers hooked over your lower teeth), hold open the jaw while trying to close against your hand pressure.
Repeat exercise at least 4 x day. Treatment may need to include bite splints, equilibration (balancing the closing of teeth to the jaw), or other options. Remember stress is almost always a factor in TMD. We can treat dental aspects of TMD but must recognize stress or anxiety aspects and take measures to deal with those. If appropriate, seek other medical care.
Crowns are a type of dental restoration which, when cemented into place, fully cap over the portion of a tooth that lies at and above the gum line. In comparison, fillings are dental restorations that fill in or cover just a portion of a tooth. Since crowns encase the entire visible aspect of a tooth, a dental crown in effect becomes the tooth’s new outer surface.
The purpose of a crown is to protect and strengthen a weakened, brittle, or badly broken tooth; i.e. a root canal tooth, or a tooth with a very large filling.
- A crown may be made out of gold, a silver colored metal, porcelain, or a combination.
- A crown is similar to a thimble fitting over a finger, and fits the tooth precisely.
- A crown is cemented or bonded to the prepared tooth.
- Porcelain crowns are at times used for cosmetic reasons. If you feel you have a need, consult your dentist..
- Crowns are expected to last 5-15 years, longer if taken care of meticulously.